Application for transfer of registration
What is a transfer of registration?
A transfer of registration is a change of the registered operator of a registered vehicle.
1
VicRoads records the identification details of each vehicle and the current registered
operator of the vehicle.
VicRoads’ vehicle register is not a register of title (vehicle ownership).
Seller instructions
You need to provide complete and accurate information so the registration can
be transferred successfully. Otherwise, you may be liable for any traffic
offences that the buyer (new registered operator) may incur.
What do I need to do?
✔ Tell the buyer if your vehicle is recorded on the Victorian or an interstate written-
off vehicles register. You must disclose this to the buyer in writing (by answering
Yes or No to this question in the Vehicle details section and provide any other
details to the buyer).
✔ Ensure your vehicle registration is still current (not suspended or cancelled),
check online at vicroads.vic.gov.au
✔ or Vehicle Identification Number (VIN)10.
Check that you are not subject to any sanctions imposed by the Director,
Fines Victoria in relation to the transfer of this vehicle.
✔ Do I need to get a Certificate of Roadworthiness (RWC)?
In most cases, yes. Give the buyer a RWC issued in Victoria no more than
30 days before the date of sale13. The registration number on the RWC must
match the number plates on the vehicle.
You do not need to provide a RWC if you transfer:
to your spouse or domestic partner
a caravan or light trailer under 4.5 tonnes GVM
a recreational motorcycle
to a Licensed Motor Car Trader (LMCT) for re-sale, demo or provision
to a secondary educational institution for driver education purposes
certain types of vehicles that are not designed primarily for carrying
passengers or goods (eg. tractor, forklift, mobile plant)
For other exemptions please check VicRoads’ website.
✔ Write a receipt for the buyer as proof of purchase and ownership and include
the registration number, VIN or chassis number and buyer and seller name.
(This transfer form cannot be used as a register of title).
✔ Complete the Seller3 details and Vehicle details sections and sign this form
with the buyer.
OR: If you sell to an LMCT, you will need to complete the form provided by them.
✔ Give the original transfer form to the buyer to submit to VicRoads.
✔ Keep one of the copies as a record of the application for transfer and date of sale.
How do I transfer with custom or personalised plates?
If you sell your vehicle with custom or personalised number plates attached and
current registration2, rights relating to the use of the number plates will pass to
the buyer.
If you want to keep the rights to your custom or personalised number plates for
future use, you need to tell VicRoads and get new number plates for your vehicle
before you transfer the registration
Post: VicRoads, GPO Box 1644, Melbourne, Victoria, 3001 Call: 13 11 71 (TTY 13 36 77, Speak and Listen 1300 555 727) Web: vicroads.vic.gov.au
Do I need to use this form?
✔ Yes: To buy or sell a vehicle with number plates attached and current registration2.
8 No: To buy or sell a vehicle without number plates and/or with cancelled registration,
do not use this form. For further information please visit vicroads.vic.gov.au
Buyer instructions
You need to provide complete and accurate information so the registration can be
transferred successfully. Otherwise, the registration will not be transferred
and may be suspended.
You should receive confirmation by mail within 14 days if your transfer is
processed successfully.
How do I check the vehicle details?
✔ Confirm the seller has the right to transfer the vehicle (ask the seller for evidence,
eg. a certificate of registration) and their identity.
✔ Confirm registration status is current (not suspended or cancelled).
Check these details online at vicroads.vic.gov.au with the registration number
✔ Confirm that the vehicle is not reported stolen, not recorded written-off and is free
of encumbrance, outstanding fines, warrants or sanctions issued by the Sheriff
(eg. money owing).
Check these details by contacting the Personal Property Security Register (PPSR)
online at ppsr.gov.au or call 1300 007 777 (1300 00PPSR)
✔ If the registration is close to expiry, a renewal notice may have already been
issued to the seller. After the transfer is processed successfully, a new one
should be sent to you by mail.
How do I complete the transfer?
✔ Ask the seller if the vehicle is recorded on the Victorian or an interstate
written-off vehicles register. If it is, they must disclose this to you in writing
(see Vehicle details section on form).
✔ Ensure number plates are attached to the vehicle. If you buy a vehicle with
custom or personalised number plates attached and current registration2,
rights relating to the use of the number plates will pass to you.
✔ Check the VIN10 or chassis number matches the registration certificate
DEDJTR11119/1 VRPIN00613 12.17 98426 Authorised and published by VicRoads, 60 Denmark Street, Kew, Victoria, 3101.
or check these details online at vicroads.vic.gov.au.
✔ Ask the seller for a Certificate of Roadworthiness (RWC)11. The registration
number on the RWC must match the number plates on the vehicle.
✔ Ask the seller for a written receipt as proof of purchase and ownership
for your records.
✔ Record the market value12 and calculate the motor vehicle duty (see how
to calculate overleaf). Penalties may apply if a person under declares the
market value.
✔ If you do not possess a Victorian driver licence/learner permit or are not an
established VicRoads client, you must present original evidence of identity
documents along with this application at a VicRoads Customer Service Centre.
✔ Complete the Buyer4 details, Transfer details and Payment sections,
check the Vehicle details section and sign this form with the seller.
✔ Give one copy to the seller and keep the other for your own records.
✔ Submit the original transfer form with relevant documents and
applicable payment (see overleaf) to VicRoads within 14 days of sale.
You may need to pay a penalty or additional fees if this is late or not submitted.
OR: If you buy from an LMCT you will need to complete the form provided by
them, and pay your transfer fee and applicable motor vehicle duty to the LMCT
who is required to forward this to VicRoads on your behalf.
BUYER INSTRUCTIONS CONTINUED OVERLEAF
Application for transfer of registration

Definitions
Buyer instructions continued
1. Registered operator – an individual or corporation who owns or manages a vehicle and
has the right to register it. To register a vehicle the individual must be at least 17 years for Do I need to provide evidence of identity?
a light vehicle, 17 years and 9 months for a motorcycle, and 18 years for a heavy vehicle. Individuals: Yes, if you do not have a Victorian driver licence/learner permit
There can only be one registered operator per vehicle (no joint registration). or a VicRoads client number, you must present full original evidence of identity
documentation with this application at a VicRoads Customer Service Centre.
2. Current registration – registration expires at midnight of the registration expiry
Companies: Yes, if you do not have a client number with VicRoads, you will need
date. VicRoads will cancel the registration if it is not renewed within three months after
to present evidence of your company with this application at a VicRoads Customer
expiry. The registration can still be transferred during this three month period, but the
Service Centre.
vehicle must not be driven until registration is renewed. If the vehicle does not meet
this definition, do not use this form and check VicRoads’ website on buying and selling Please check vicroads.vic.gov.au for requirements.
(not a transfer). How do I lodge this application?
For heavy vehicles registered under part-year registration see VicRoads’ website. You must submit this form with relevant documents (eg. RWC) and applicable
3. Seller – the individual or corporation (current registered operator) who is disposing of payment within 14 days of sale by:
the vehicle. It may be sold or given away for free. mail (cheque or money order) to:
GPO Box 1644, Melbourne Victoria 3001
4. Buyer – the individual or corporation who is acquiring the vehicle (proposed registered
operator). It may be paid for or received as a gift. Payment can also be made at a VicRoads Customer Service Centre using Mastercard
or Visa. A card payment fee will apply in addition to any amounts payable. Details of
5. Surname and given name(s) – must match the name on an individual’s Victorian the fee are available at vicroads.vic.gov.au. A confirmation advice will be sent
licence or evidence of identity documents. to you within 14 days of a successful transfer of the vehicle registration.
Important: If you need to provide evidence of identity, present your original documents
6. Company name – the name of a corporation registered with the Australian Securities
along with this application in person at a VicRoads Customer Service Centre. If you are
and Investments Commission (ASIC). For example, ‘Sample Cars Pty Ltd’.
required to provide evidence of identity, your application for a transfer of registration will
Trading names cannot be used to register a vehicle. be processed at the VicRoads Customer Service Centre that you attend.
7. Australian Company Number (ACN) – a unique nine digit number issued to a Check vicroads.vic.gov.au or call (03) 8677 7855.
company by Australian Securities and Investments Commission (ASIC). How do I apply on behalf of someone else or a company?
Australian Business Numbers (ABNs) cannot be used to register a vehicle. You must provide evidence of identity and an original signed letter of authority to
8. Victorian licence / client number – provide a Victorian driver licence/learner act on behalf of another person or a company at a VicRoads Customer Service
permit number for a licence/learner permit holder or a client number for a corporation. Centre. The letter must nominate the vehicle to be transferred.
A client number is a unique nine digit number issued by VicRoads to corporations For deceased estates, refer to the Deceased Estate Pack or VicRoads’ website
and individuals without a Victorian licence or learner permit. If you are an established for further information.
VicRoads client, but do not know your client number, please ensure all other details
are completed. Do I need to pay fees?
Individuals who do not have a Victorian driver licence/learner permit number, and Yes, the buyer needs to pay a transfer fee, declare market value of the
individuals or corporations who are not an established VicRoads client, will need to vehicle and pay motor vehicle duty (if applicable).
present full evidence of identity documentation with this application at a VicRoads
Customer Service Centre. Transfer fees
9. Garage address – where the vehicle will normally be kept (eg. home, office or heavy Motor vehicle - $39.10
vehicle depot). VicRoads will only register vehicles garaged in Victoria. If the garage Motorcycle/Trailer/Caravan - $6.30
address is (or will be) in another state you must register the vehicle there. If you change Fees are subject to change. A card payment fee will apply for Mastercard or Visa
any of your details you must notify VicRoads within 14 days. payments. For further information visit vicroads.vic.gov.au.
Market value
10. Vehicle Identification Number (VIN) – a unique 17 digit identifier made up of
numbers and letters on a vehicle. If there is no VIN (eg. on pre 1989 vehicles), provide You must declare the correct market value (the price at which the vehicle might
a chassis number. reasonably be sold, free from encumbrances, on the open market; or the purchase
price – whichever is greater).
11. Certificate of Roadworthiness (RWC) – also known as a Roadworthy Certificate,
issued by a Victorian Licensed Vehicle Tester to certify if a vehicle is in roadworthy Do I need to pay motor vehicle duty?
condition. It is valid for 30 days from the date of issue, unless a defect notice is issued In most cases, yes. The amount of motor vehicle duty payable is $8.40 for every
within the period of validity. $200 or part thereof of the market value. You do not need to pay motor vehicle
The seller must give the buyer an original and current RWC to apply for transfer of duty if the transfer falls under one of the following exemptions:
registration (some exemptions apply, see seller instructions on the previous page). between spouses or domestic partners
12. Market value – also known as dutiable value, is the price at which the vehicle might a caravan or light trailer under 4.5 tonnes GVM
reasonably be sold, free from encumbrances, on the open market; or the purchase to a Licensed Motor Car Trader (LMCT) for re-sale, demo or provision
price – whichever is greater. to a secondary educational institution for driver education purposes
For example, if you paid $4000 but it would normally be worth $5000, the market value is $5000. to a primary producer (a special vehicle, special purpose vehicle, tractor,
trailer or item of agricultural equipment only)
For example, if you pay greater than the normal market value due to a vehicle’s condition, the
dutiable value is the amount paid. For other exemptions please check VicRoads’ website.
You can calculate motor vehicle duty online at vicroads.vic.gov.au
13. Date of sale – refers to the date of transfer or delivery, when the buyer acquires the
vehicle from the seller. How to calculate
motor vehicle duty Example calculation
Penalties Market value Market value
The seller (disposer) must inform the buyer in writing if the vehicle is recorded on the Victorian or an interstate $ ÷200 = A $ 12,420 ÷200 = 62.1 A
written-off vehicles register. Failure to do so may result in a penalty of over $1000. The buyer (acquirer) must
complete and sign this application with the seller and submit to VicRoads with relevant documents and pay the
applicable motor vehicle duty and transfer fee within 14 days of sale. Failure to do so may result in a penalty of over ROUND UP A to the ROUND UP A to the
$500. If the buyer is not a Licensed Motor Car Trader (dealer) and acquires a vehicle from a dealer, the buyer must, next whole number Motor next whole number Motor
at the time of acquiring the vehicle, complete an application for transfer of registration form as acquirer, sign it and (no decimals) vehicle duty (no decimals) vehicle duty
give it to the dealer; and unless the dealer otherwise agrees, pay to the dealer the applicable motor vehicle duty and
transfer fee. Failure to do so may result in a penalty of over $1000. (Road Safety (Vehicles) Regulations 2009) x 8.4 = $ 63 x 8.4 = $ 529.2
This application for transfer of registration of a motor vehicle is an assessment of duty (section 217A). A person who
under declares the market value is liable to a penalty equal to double the amount of duty underpaid (section 215). A
person who underpays the motor vehicle duty is also liable to a penalty equal to the amount underpaid plus interest
(section 217). (Duties Act 2000)
A person who underpays the motor vehicle duty may be also liable to penalty tax and interest.
(Taxation Administration Act 1997)

Post: VicRoads, GPO Box 1644, Melbourne, Victoria, 3001 Call: 13 11 71 (TTY 13 36 77, Speak and Listen 1300 555 727) Web: vicroads.vic.gov.au
Application for transfer of registration
This form must be completed and signed by both the seller3 and buyer4 and returned to VicRoads within 14 days of sale.
For correct processing, please print clearly in ink using BLOCK letters. All details should be provided including the licence number for all Victorian licence holders.
VicRoads’ vehicle register is not a register of title (vehicle ownership).

Seller details Buyer details

Surname5 OR company name6 Surname5 OR company name6

Given name(s)5 OR ACN7 (if applicable) Given name(s)5 OR ACN7 (if applicable)

Victorian licence / client no.8 Date of birth Victorian licence / learner permit Date of birth1
/ client no.8
D D M M Y Y Y Y
D D M M Y Y Y Y
Home (or company) address
Home (or company) address

Postcode
Postcode
Postal address (if different from above)
Garage address9 (if different from above)

Postcode
Postcode
Phone (mobile preferred) Email
Postal address (if different from above)

Vehicle details Postcode

Registration number Date of registration expiry

Phone (mobile preferred) Email
D D M M Y Y Y Y

Year Make
Transfer details
Market value12 of the vehicle Date of sale13
Model Body type $ D D M M Y Y Y Y
To avoid penalties do not under declare the To avoid liability for traffic offences and penalties
market value. the exact date of sale must be shown.
VIN10 (or chassis number if no VIN)
Payment
To avoid penalties the duty and fees should be paid when the application is lodged.
Is this vehicle recorded on the Victorian or interstate written-off Exemption code Motor
vehicles register? Transfer fee vehicle duty Total payable

DEDJTR11119/1 VRPIN00613 12.17 98426 Authorised and published by VicRoads, 60 Denmark Street, Kew, Victoria, 3101.
(office use only)

Yes Further information about written-off vehicles is available at VicRoads’ website. $ + $ = $

No
Have you attached an original Certificate of Roadworthiness (RWC)11 By signing this form, I declare that all information and/or documents provided by me is true and correct
and I understand the Privacy statement. I acknowledge that a copy of this form may be provided by
issued in Victoria not more than 30 days before the date of sale? VicRoads to the seller (disposer) upon request. I have checked the vehicle details provided by the seller
Yes match the vehicle and agree on the market value of the vehicle as declared on this form.

No You must attach a RWC for the form to be processed (unless exempt)11. Signature of buyer
Date
RWC serial number RWC issue date
D D M M Y Y Y Y
D D M M Y Y Y Y

RWC tester’s licence number

Privacy statement
EX Personal information VicRoads collects from you may be used by VicRoads, as permitted by the Road Safety
Act 1986 and the Marine Safety Act 2010. VicRoads may disclose personal information it collects from you to
various organisations and persons as permitted by law, particularly by the Road Safety Act 1986. This includes
By signing this form, I declare that all information and/or documents provided by me is true and correct and
I understand the Privacy statement. I acknowledge that a copy of this form may be provided by VicRoads to disclosing the information to contractors and agents of VicRoads, law enforcement agencies, other road and
the buyer (acquirer) upon request. I have informed the buyer that this vehicle is recorded on the Victorian traffic authorities, Austroads, the Transport Accident Commission, vehicle manufacturers (for safety recalls),
or an interstate written-off vehicles register (if applicable). I agree with the buyer on the market value of the road safety researchers, courts and other organisations or people authorised to use the personal information.
vehicle as declared on this form. I declare that this vehicle is registered at the date of sale and acknowledge You are required to provide this personal information. Failure to provide the information may result in this form
that any remaining period of registration of this vehicle is transferred to the buyer. not being processed, or records not being properly maintained. For further information about our use of your
personal information and your right of access to it, see VicRoads brochure Protecting your privacy or contact
I declare that I am not subject to any sanctions imposed by the Director, Fines Victoria that will prevent VicRoads on 13 11 71.
the transfer of this vehicle.
Providing false and/or misleading information or documents is a serious offence under
Signature of seller the Road Safety Act 1986 and/or Marine Safety Act 2010 and can result in you being fined
Date or imprisoned. Any authority or approval, given as a result of you providing such
information/documents, may be reversed and have no effect.
D D M M Y Y Y Y By signing this form, I declare that the information in this form and related supporting
documents is true, correct and complete, and I understand the privacy statement.

THIS ORIGINAL MUST BE SUBMITTED TO VICROADS BY THE BUYER

Application for transfer of registration
BUYER TO RETAIN THIS CARBON COPY

Seller details Buyer details

Surname5 OR company name6 Surname5 OR company name6

Given name(s)5 OR ACN7 (if applicable) Given name(s)5 OR ACN7 (if applicable)

Victorian licence / client no.8 Date of birth Victorian licence / learner permit Date of birth1
/ client no.8
D D M M Y Y Y Y
D D M M Y Y Y Y
Home (or company) address
Home (or company) address

Postcode
Postcode
Postal address (if different from above)
Garage address9 (if different from above)

Postcode
Postcode
Phone (mobile preferred) Email
Postal address (if different from above)

Vehicle details Postcode

Registration number Date of registration expiry

Phone (mobile preferred) Email
D D M M Y Y Y Y
Year Make

Transfer details
Market value12 of the vehicle Date of sale13
Model Body type
$ D D M M Y Y Y Y
To avoid penalties do not under declare the To avoid liability for traffic offences and penalties
market value. the exact date of sale must be shown.
VIN10 (or chassis number if no VIN)
Payment
To avoid penalties the duty and fees should be paid when the application is lodged.
Is this vehicle recorded on the Victorian or interstate written-off Motor
Exemption code
vehicles register? (office use only) Transfer fee vehicle duty Total payable

DEDJTR11119/1 VRPIN00613 12.17 98426 Authorised and published by VicRoads, 60 Denmark Street, Kew, Victoria, 3101.
Yes Further information about written-off vehicles is available at VicRoads’ website. $ + $ = $
No
Have you attached an original Certificate of Roadworthiness (RWC)11 By signing this form, I declare that all information and/or documents provided by me is true and correct
issued in Victoria not more than 30 days before the date of sale? and I understand the Privacy statement. I acknowledge that a copy of this form may be provided by
VicRoads to the seller (disposer) upon request. I have checked the vehicle details provided by the seller
Yes match the vehicle and agree on the market value of the vehicle as declared on this form.
No You must attach a RWC for the form to be processed (unless exempt)11. Signature of buyer
Date
RWC serial number RWC issue date
D D M M Y Y Y Y
D D M M Y Y Y Y

RWC tester’s licence number

EX
Privacy statement
Personal information VicRoads collects from you may be used by VicRoads, as permitted by the Road Safety
Act 1986 and the Marine Safety Act 2010. VicRoads may disclose personal information it collects from you to
By signing this form, I declare that all information and/or documents provided by me is true and correct and various organisations and persons as permitted by law, particularly by the Road Safety Act 1986. This includes
I understand the Privacy statement. I acknowledge that a copy of this form may be provided by VicRoads to disclosing the information to contractors and agents of VicRoads, law enforcement agencies, other road and
the buyer (acquirer) upon request. I have informed the buyer that this vehicle is recorded on the Victorian traffic authorities, Austroads, the Transport Accident Commission, vehicle manufacturers (for safety recalls),
or an interstate written-off vehicles register (if applicable). I agree with the buyer on the market value of the road safety researchers, courts and other organisations or people authorised to use the personal information.
vehicle as declared on this form. I declare that this vehicle is registered at the date of sale and acknowledge You are required to provide this personal information. Failure to provide the information may result in this form
that any remaining period of registration of this vehicle is transferred to the buyer. not being processed, or records not being properly maintained. For further information about our use of your
personal information and your right of access to it, see VicRoads brochure Protecting your privacy or contact
I declare that I am not subject to any sanctions imposed by the Director, Fines Victoria that will prevent
VicRoads on 13 11 71.
the transfer of this vehicle.
Providing false and/or misleading information or documents is a serious offence under
Signature of seller the Road Safety Act 1986 and/or Marine Safety Act 2010 and can result in you being fined
Date or imprisoned. Any authority or approval, given as a result of you providing such
information/documents, may be reversed and have no effect.
D D M M Y Y Y Y By signing this form, I declare that the information in this form and related supporting
documents is true, correct and complete, and I understand the privacy statement.

THIS COPY SHOULD BE KEPT BY THE BUYER

Application for transfer of registration
SELLER TO RETAIN THIS CARBON COPY

Seller details Buyer details

Surname5 OR company name6 Surname5 OR company name6

Given name(s)5 OR ACN7 (if applicable) Given name(s)5 OR ACN7 (if applicable)

Victorian licence / client no.8 Date of birth Victorian licence / learner permit Date of birth1
/ client no.8
D D M M Y Y Y Y
D D M M Y Y Y Y
Home (or company) address
Home (or company) address

Postcode
Postcode
Postal address (if different from above)
Garage address9 (if different from above)

Postcode
Postcode
Phone (mobile preferred) Email
Postal address (if different from above)

Vehicle details Postcode

Registration number Date of registration expiry

Phone (mobile preferred) Email
D D M M Y Y Y Y
Year Make

Transfer details
Market value12 of the vehicle Date of sale13
Model Body type
$ D D M M Y Y Y Y
To avoid penalties do not under declare the To avoid liability for traffic offences and penalties
market value. the exact date of sale must be shown.
VIN10 (or chassis number if no VIN)
Payment
To avoid penalties the duty and fees should be paid when the application is lodged.
Is this vehicle recorded on the Victorian or interstate written-off Motor
Exemption code
vehicles register? (office use only) Transfer fee vehicle duty Total payable

DEDJTR11119/1 VRPIN00613 12.17 98426 Authorised and published by VicRoads, 60 Denmark Street, Kew, Victoria, 3101.
Yes Further information about written-off vehicles is available at VicRoads’ website. $ + $ = $
No
Have you attached an original Certificate of Roadworthiness (RWC)11 By signing this form, I declare that all information and/or documents provided by me is true and correct
issued in Victoria not more than 30 days before the date of sale? and I understand the Privacy statement. I acknowledge that a copy of this form may be provided by
VicRoads to the seller (disposer) upon request. I have checked the vehicle details provided by the seller
Yes match the vehicle and agree on the market value of the vehicle as declared on this form.
No You must attach a RWC for the form to be processed (unless exempt)11. Signature of buyer
Date
RWC serial number RWC issue date
D D M M Y Y Y Y
D D M M Y Y Y Y

RWC tester’s licence number

EX
Privacy statement
Personal information VicRoads collects from you may be used by VicRoads, as permitted by the Road Safety
Act 1986 and the Marine Safety Act 2010. VicRoads may disclose personal information it collects from you to
By signing this form, I declare that all information and/or documents provided by me is true and correct and various organisations and persons as permitted by law, particularly by the Road Safety Act 1986. This includes
I understand the Privacy statement. I acknowledge that a copy of this form may be provided by VicRoads to disclosing the information to contractors and agents of VicRoads, law enforcement agencies, other road and
the buyer (acquirer) upon request. I have informed the buyer that this vehicle is recorded on the Victorian traffic authorities, Austroads, the Transport Accident Commission, vehicle manufacturers (for safety recalls),
or an interstate written-off vehicles register (if applicable). I agree with the buyer on the market value of the road safety researchers, courts and other organisations or people authorised to use the personal information.
vehicle as declared on this form. I declare that this vehicle is registered at the date of sale and acknowledge You are required to provide this personal information. Failure to provide the information may result in this form
that any remaining period of registration of this vehicle is transferred to the buyer. not being processed, or records not being properly maintained. For further information about our use of your
personal information and your right of access to it, see VicRoads brochure Protecting your privacy or contact
I declare that I am not subject to any sanctions imposed by the Director, Fines Victoria that will prevent
VicRoads on 13 11 71.
the transfer of this vehicle.
Providing false and/or misleading information or documents is a serious offence under
Signature of seller the Road Safety Act 1986 and/or Marine Safety Act 2010 and can result in you being fined
Date or imprisoned. Any authority or approval, given as a result of you providing such
information/documents, may be reversed and have no effect.
D D M M Y Y Y Y By signing this form, I declare that the information in this form and related supporting
documents is true, correct and complete, and I understand the privacy statement.

THIS COPY SHOULD BE KEPT BY THE SELLER

Credit or debit card authorisation
For correct processing, please print clearly in ink using BLOCK letters.

Credit or debit card authorisation (mailed payments only)

If paying by credit or debit card, please provide your card details and your authorisation for card payment here. Please note: a card payment fee will apply when using Mastercard
or Visa. For further information visit vicroads.vic.gov.au.

Mail this section to: GPO Box 1644, Melbourne Vic 3000

Card Type

Visa Mastercard

Name of cardholder

Credit or debit card no.

Total payable amount Date of expiry

$ M M Y Y

Signature

Date
D D M M Y Y Y Y

Important: terms for credit card use

1. As the cardholder I acknowledge and accept that a card payment fee will apply to the transaction, and that details of the fee are available at vicroads.vic.gov.au.
By signing this form I authorise VicRoads to deduct the card payment fee in addition to any amounts payable.
2. VicRoads will arrange for funds to be debited from your nominated credit or debit card as authorised by you within fourteen (14) days of your form submission.
3. It is your responsibility to ensure that you have sufficient credit available on your credit or debit card within fourteen (14) days of submitting your form to cover your payment
and that your card details are current and correct.
4. Should your credit or debit card payment default, VicRoads will notify you immediately and allow seven (7) days for you to respond with alternative payment.
5. If your declared payable amount is insufficient, VicRoads will notify you immediately and allow seven (7) days for you to pay the balance outstanding.
6. Should a response not be received within the seven (7) days allowed VicRoads may take action to suspend your registration.
7. If you believe that there has been an error in debiting your credit or debit card you should notify us immediately on 13 11 71 so that we can resolve your query promptly.

THIS ORIGINAL MUST BE SUBMITTED TO VICROADS BY THE BUYER